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Based on record review, policy review and interviews with hospital staff, the hospital failed to ensure that restraints are used in accordance with the order of a physician who is responsible for the care of the patient. Orders were not obtained timely or complete in one of three records (patient's #1,2,and 3 ) reviewed of patients that had restraints implemented.
Findings:

1. In one patient record, patient (# 1) who had restraints implemented, Employee G recorded initiating a vest restraint at 0415 on 05/05/10. The physician order was not obtained until 09:12 a.m. on 5/5/10.

2. On 5/6/10 at 9:55 a.m., patient record #1 contained one (1) restraint order which did not have the type of restraint to be utilized documented.

Based on review of hospital hospital documents and training documentation provided, and interviews with hospital staff, the hospital failed to ensure all staff who have direct patient contact are trained and kept current in the proper and safe use of seclusion and restraints. Of the licensed personnel involved in patient #1's care, one of nine licensed personnel did not have training documented in their personnel file

Findings:

1. The hospital's policy required staff to be trained during initial hire orientation and annually thereafter in use of restraints. This program contain both verbal and physical components. This was confirmed by interview with the Employee F and the administrators 5/11/2010.

2. Employee training data were provided to surveyors and reviewed on the afternoon of 05/11/2010. The surveyor reviewed the findings in the presence of Employee F. One of nine (G-O) personnel actively involved in the care of patient #1 did not have restraint training. Employee G, who selected the type and initiated the restraints, did not have orientation or training in the use of restraints. This was confirmed at the time with Employee F.